Sex hormones and adipose tissue distribution in premenopausal cigarette smokers

Androgen dominance is associated with android (abdominal) adiposity and increased health risk. Cigarette smoking has an anti-estrogenic effect in women and recent evidence has linked cigarette smoking with abdominally-localized adipose tissue. The relationship between cigarette smoking, endogenous sex steroid levels and adipose tissue distribution in women has not been examined. We assessed anthropometric indicators of fat distribution and serum levels of estradiol, testosterone and sex hormone-binding globulin (SHBG) in 56 women aged 20-35 years (27 cigarette smokers and 29 non-smokers). Free estradiol and testosterone were estimated. Endocrine and anthropometric variables were adjusted for overall fatness. Cigarette smokers had significantly higher mean serum levels of SHBG than non-smokers (63.38nmol/l and 57.85nmol/l, respectively; P<0.01); there were no differences in serum estradiol, testosterone or estimated free levels of these sex steroids. Cigarette smokers had a more android distribution of adipose tissue: significantly greater waist-to-hip ratio (WHR) (P<0.01), greater waist-to-thigh ratio (WTR) (P<0.02) and smaller thigh girth (P<0.05). Waist and umbilical girths were greater in cigarette smokers (P<0.0002), but there was no difference in the sum of central skinfold thicknesses (abdominal, iliac crest and supra-spinale). A significant interaction (P<0.05) of cigarette smoking with serum testosterone levels was observed in effects on WHR; the relative impact of serum testosterone upon abdominal adiposity was greater in cigarette smokers than in non-smokers. The results suggest that in premenopausal women, cigarette smoking promotes android adiposity by increasing abdominal fat deposition and decreasing femoral fat deposition via interactive effects with sex steroids. The results also suggest an effect of cigarette smoking on serum SHBG, independent of effects on androgen/estrogen balance.